Treatment for Mild Chronic Hypertension during Pregnancy
dc.contributor.author | Tita, Alan T. | |
dc.contributor.author | Szychowski, Jeff M. | |
dc.contributor.author | Boggess, Kim | |
dc.contributor.author | Dugoff, Lorraine | |
dc.contributor.author | Sibai, Baha | |
dc.contributor.author | Lawrence, Kirsten | |
dc.contributor.author | Hughes, Brenna L. | |
dc.contributor.author | Bell, Joseph | |
dc.contributor.author | Aagaard, Kjersti | |
dc.contributor.author | Edwards, Rodney K. | |
dc.contributor.author | Gibson, Kelly | |
dc.contributor.author | Haas, David M. | |
dc.contributor.author | Plante, Lauren | |
dc.contributor.author | Metz, Torri | |
dc.contributor.author | Casey, Brian | |
dc.contributor.author | Esplin, Sean | |
dc.contributor.author | Longo, Sherri | |
dc.contributor.author | Hoffman, Matthew | |
dc.contributor.author | Saade, George R. | |
dc.contributor.author | Hoppe, Kara K. | |
dc.contributor.author | Foroutan, Janelle | |
dc.contributor.author | Tuuli, Methodius | |
dc.contributor.author | Owens, Michelle Y. | |
dc.contributor.author | Simhan, Hyagriv N. | |
dc.contributor.author | Frey, Heather | |
dc.contributor.author | Rosen, Todd | |
dc.contributor.author | Palatnik, Anna | |
dc.contributor.author | Baker, Susan | |
dc.contributor.author | August, Phyllis | |
dc.contributor.author | Reddy, Uma M. | |
dc.contributor.author | Kinzler, Wendy | |
dc.contributor.author | Su, Emily | |
dc.contributor.author | Krishna, Iris | |
dc.contributor.author | Nguyen, Nicki | |
dc.contributor.author | Norton, Mary E. | |
dc.contributor.author | Skupski, Daniel | |
dc.contributor.author | El-Sayed, Yasser Y. | |
dc.contributor.author | Ogunyemi, Dotum | |
dc.contributor.author | Galis, Zorina S. | |
dc.contributor.author | Harper, Lorie | |
dc.contributor.author | Ambalavanan, Namasivayam | |
dc.contributor.author | Geller, Nancy L. | |
dc.contributor.author | Oparil, Suzanne | |
dc.contributor.author | Cutter, Gary R. | |
dc.contributor.author | Andrews, William W. | |
dc.contributor.author | Chronic Hypertension and Pregnancy (CHAP) Trial Consortium | |
dc.contributor.department | Obstetrics and Gynecology, School of Medicine | |
dc.date.accessioned | 2024-05-06T15:41:26Z | |
dc.date.available | 2024-05-06T15:41:26Z | |
dc.date.issued | 2022 | |
dc.description.abstract | Background: The benefits and safety of the treatment of mild chronic hypertension (blood pressure, <160/100 mm Hg) during pregnancy are uncertain. Data are needed on whether a strategy of targeting a blood pressure of less than 140/90 mm Hg reduces the incidence of adverse pregnancy outcomes without compromising fetal growth. Methods: In this open-label, multicenter, randomized trial, we assigned pregnant women with mild chronic hypertension and singleton fetuses at a gestational age of less than 23 weeks to receive antihypertensive medications recommended for use in pregnancy (active-treatment group) or to receive no such treatment unless severe hypertension (systolic pressure, ≥160 mm Hg; or diastolic pressure, ≥105 mm Hg) developed (control group). The primary outcome was a composite of preeclampsia with severe features, medically indicated preterm birth at less than 35 weeks' gestation, placental abruption, or fetal or neonatal death. The safety outcome was small-for-gestational-age birth weight below the 10th percentile for gestational age. Secondary outcomes included composites of serious neonatal or maternal complications, preeclampsia, and preterm birth. Results: A total of 2408 women were enrolled in the trial. The incidence of a primary-outcome event was lower in the active-treatment group than in the control group (30.2% vs. 37.0%), for an adjusted risk ratio of 0.82 (95% confidence interval [CI], 0.74 to 0.92; P<0.001). The percentage of small-for-gestational-age birth weights below the 10th percentile was 11.2% in the active-treatment group and 10.4% in the control group (adjusted risk ratio, 1.04; 95% CI, 0.82 to 1.31; P = 0.76). The incidence of serious maternal complications was 2.1% and 2.8%, respectively (risk ratio, 0.75; 95% CI, 0.45 to 1.26), and the incidence of severe neonatal complications was 2.0% and 2.6% (risk ratio, 0.77; 95% CI, 0.45 to 1.30). The incidence of any preeclampsia in the two groups was 24.4% and 31.1%, respectively (risk ratio, 0.79; 95% CI, 0.69 to 0.89), and the incidence of preterm birth was 27.5% and 31.4% (risk ratio, 0.87; 95% CI, 0.77 to 0.99). Conclusions: In pregnant women with mild chronic hypertension, a strategy of targeting a blood pressure of less than 140/90 mm Hg was associated with better pregnancy outcomes than a strategy of reserving treatment only for severe hypertension, with no increase in the risk of small-for-gestational-age birth weight. | |
dc.eprint.version | Author's manuscript | |
dc.identifier.citation | Tita AT, Szychowski JM, Boggess K, et al. Treatment for Mild Chronic Hypertension during Pregnancy. N Engl J Med. 2022;386(19):1781-1792. doi:10.1056/NEJMoa2201295 | |
dc.identifier.uri | https://hdl.handle.net/1805/40500 | |
dc.language.iso | en_US | |
dc.publisher | Massachusetts Medical Society | |
dc.relation.isversionof | 10.1056/NEJMoa2201295 | |
dc.relation.journal | The New England Journal of Medicine | |
dc.rights | Publisher Policy | |
dc.source | PMC | |
dc.subject | Abruptio placentae | |
dc.subject | Fetal growth retardation | |
dc.subject | Hypertension | |
dc.subject | Pre-eclampsia | |
dc.subject | Premature birth | |
dc.title | Treatment for Mild Chronic Hypertension during Pregnancy | |
dc.type | Article |